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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 010213903
Report Date: 08/23/2023
Date Signed: 08/23/2023 04:09:23 PM

Document Has Been Signed on 08/23/2023 04:09 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:MONTESSORI SCHOOL AT WASHINGTON AVENUEFACILITY NUMBER:
010213903
ADMINISTRATOR:YOUSSEF, MARIANFACILITY TYPE:
850
ADDRESS:14795 WASHINGTON AVENUETELEPHONE:
(510) 357-8432
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY: 111TOTAL ENROLLED CHILDREN: 111CENSUS: 58DATE:
08/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Director Marian YoussefTIME COMPLETED:
04:30 PM
NARRATIVE
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On Wednesday, August 23, 2023 at 11 am, Licensing Program Analysts (LPAs) Manel Estoesta and Jaleesa Jackson conducted a Plan of Correction (POC) visit. LPAs met with Director Marian "Mira" Youssef and explained the nature of the visit. Present on this visit were 8 staff and 58 preschool children in care. The facility operates from Monday to Friday from 7 am to 6 am.

On 8/2/2023, the Licensee had 2 Type A Repeat Violation with a POC due date on 08/9/2023. LPA Estoesta received the proof of the POC on August 16, 2023 via mail with a date stamped on 08/10/2023.

LPAs advised the Director of the Licensee's Failure to Correct - Civil Penalty Assessment.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Director Marian "Mira" Youssef.

SUPERVISORS NAME: Jason Jang
LICENSING EVALUATOR NAME: Manel Estoesta
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/23/2023 04:09 PM - It Cannot Be Edited


Created By: Manel Estoesta On 08/23/2023 at 01:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612

FACILITY NAME: MONTESSORI SCHOOL AT WASHINGTON AVENUE
FACILITY NUMBER: 010213903

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/23/2023
Section Cited
CCR
101212(d)(C)

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Section Reporting Requirements 101212 (d)(1)(C) Any unusual incident or child absence that threatens the physical or emotional health or safety of any child........
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Email received Friday, August 18, 2023 5:09 PM. Cleared by visit.
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FAILURE TO CORRECT on or by POC date - SEE LIC 809 dated 8/2/23.
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Type B
08/23/2023
Section Cited
CCR101216.3(a)

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(a) There shall be a ratio of one teacher visually observing and supervising no more than 12 children in attendance, except as specified in (b) and (c) below.......
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Email received Friday, August 18, 2023 5:09 PM. Cleared by visit.
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FAILURE TO CORRECT on or by POC date - SEE LIC 809 dated 8/2/23.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jason Jang
LICENSING EVALUATOR NAME:Manel Estoesta
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2023


LIC809 (FAS) - (06/04)
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